Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Complicated Cystitis

Oral Treatment

Nitrofurantoin (Macrobid) 100mg PO Q12h x 7 days

ONLY if CrCl ≥30 mL/min

OR

Trimethoprim/sulfamethoxazole (SMX/TMP) 1 DS PO Q12h x 7 days

  • Avoid if prior urinary culture with SMX/TMP-resistant bacteria or if used within 12 months

  • Can be used in patients with decreased renal function:

    • If CrCl <30 mL/min, reduce dose to 1 SS PO Q12h

  • Use with caution in pregnant females

IV Treatment

IV Treatment Options (If Indicated)

If Contraindications To All First-Line Therapies

Cephalexin 500mg PO Q8h for 7-10 days

OR

Amoxicillin/Clavulanic acid 500mg/125mg PO Q12h for 7-10 days

OR

Ciprofloxacin 250mg PO Q12h x 3 days

Fluoroquinolones are considered only a last resort for patients with cystitis in the absence of risk factors for fluoroquinolone resistance

ESBL-Producing Enterobacteriaceae

Fosfomycin 3 G PO Q72h x 3 doses

Non-β-lactam antibiotics often retain activity against ESBL-producing Enterobacteriaceae if not previously used

Vancomycin-resistant Enterococcus (VRE)

Fosfomycin 3 G PO Q72h x 2 doses

Only indicated for symptomatic patients. Growth of VRE in a urine culture often indicates urinary colonization due to recent use of antibiotics, not a urinary infection